Spinocerebellar Ataxias

脊髓小脑共济失调
  • 文章类型: Journal Article
    脊髓小脑性共济失调(SCAs)是神经系统的一大类遗传性退行性疾病,尤其是小脑,和其他表现为各种渐进运动的系统,认知,以小脑共济失调为主要症状的行为缺陷。SCA通常会导致患者功能严重受损,生活质量,和预期寿命。对于SCA,没有被证明有效的药物疗法可以改善症状或大大延迟疾病进展,即,疾病修饰疗法。为了研究SCA的发病机制和潜在的治疗方法,动物模型已被广泛使用,是临床前研究的重要组成部分。它们主要包括老鼠,还有其他脊椎动物和无脊椎动物。每种动物模型都有其优势和劣势,源于模型动物物种,遗传操作的类型,与人类疾病相似。SCA的鼠和非鼠模型的类型,他们对SCA发病机制研究的贡献,病理表型,并对其治疗方法及其优缺点进行了综述。专家小组之间达成共识:(1)动物模型代表了有价值的工具,可以提高我们对SCA的理解,并发现和评估这组神经系统疾病的新疗法,其特征在于不同的机制和不同的退行性进展。(2)研究治疗方法需要对单个动物模型进行彻底的表型评估,(3)需要进行比较研究,以使临床前研究更接近临床试验,和(4)小鼠模型补充细胞和无脊椎动物模型,所述细胞和无脊椎动物模型在复杂神经障碍如SCA的临床翻译方面仍然有限。
    Spinocerebellar ataxias (SCAs) represent a large group of hereditary degenerative diseases of the nervous system, in particular the cerebellum, and other systems that manifest with a variety of progressive motor, cognitive, and behavioral deficits with the leading symptom of cerebellar ataxia. SCAs often lead to severe impairments of the patient\'s functioning, quality of life, and life expectancy. For SCAs, there are no proven effective pharmacotherapies that improve the symptoms or substantially delay disease progress, i.e., disease-modifying therapies. To study SCA pathogenesis and potential therapies, animal models have been widely used and are an essential part of pre-clinical research. They mainly include mice, but also other vertebrates and invertebrates. Each animal model has its strengths and weaknesses arising from model animal species, type of genetic manipulation, and similarity to human diseases. The types of murine and non-murine models of SCAs, their contribution to the investigation of SCA pathogenesis, pathological phenotype, and therapeutic approaches including their advantages and disadvantages are reviewed in this paper. There is a consensus among the panel of experts that (1) animal models represent valuable tools to improve our understanding of SCAs and discover and assess novel therapies for this group of neurological disorders characterized by diverse mechanisms and differential degenerative progressions, (2) thorough phenotypic assessment of individual animal models is required for studies addressing therapeutic approaches, (3) comparative studies are needed to bring pre-clinical research closer to clinical trials, and (4) mouse models complement cellular and invertebrate models which remain limited in terms of clinical translation for complex neurological disorders such as SCAs.
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  • 文章类型: Consensus Development Conference
    近年来致力于了解脊髓小脑共济失调(SCA)的分子机制或神经变性的深入研究正在确定新的途径和靶标,从而提供了新的见解,并更好地了解了这些疾病的分子发病机理。在这份共识手稿中,作者讨论了他们目前对确定的导致或调节脊髓小脑共济失调神经退行性表型的分子过程的看法,以及将获得的新知识转化为治疗候选靶点的共同观点。讨论了以下主题:转录失调,蛋白质聚集,自噬,离子通道,线粒体的作用,RNA毒性,神经变性的调节剂和当前的治疗方法。共识的总体观点包括SCA中神经变性的共同愿景,作为多因素,渐进和可逆过程,至少在早期阶段。共识的具体观点包括蛋白质折叠失调的作用,转录,生物能学,在SCA疾病进展期间,钙处理和最终的细胞死亡以及神经元的凋亡特征。尚未解决的问题包括这些途径的失调如何触发症状的发作并介导疾病进展,因为这种理解可能允许在可逆性窗口内有效治疗SCA,以防止早期神经元损伤。常见的意见还包括需要临床检测早期神经元功能障碍,更多的基础研究来破译SCA中的早期神经退行性过程,以产生新的概念,用于治疗策略和将结果转化为临床前研究,此后,在临床实践中。
    Intensive scientific research devoted in the recent years to understand the molecular mechanisms or neurodegeneration in spinocerebellar ataxias (SCAs) are identifying new pathways and targets providing new insights and a better understanding of the molecular pathogenesis in these diseases. In this consensus manuscript, the authors discuss their current views on the identified molecular processes causing or modulating the neurodegenerative phenotype in spinocerebellar ataxias with the common opinion of translating the new knowledge acquired into candidate targets for therapy. The following topics are discussed: transcription dysregulation, protein aggregation, autophagy, ion channels, the role of mitochondria, RNA toxicity, modulators of neurodegeneration and current therapeutic approaches. Overall point of consensus includes the common vision of neurodegeneration in SCAs as a multifactorial, progressive and reversible process, at least in early stages. Specific points of consensus include the role of the dysregulation of protein folding, transcription, bioenergetics, calcium handling and eventual cell death with apoptotic features of neurons during SCA disease progression. Unresolved questions include how the dysregulation of these pathways triggers the onset of symptoms and mediates disease progression since this understanding may allow effective treatments of SCAs within the window of reversibility to prevent early neuronal damage. Common opinions also include the need for clinical detection of early neuronal dysfunction, for more basic research to decipher the early neurodegenerative process in SCAs in order to give rise to new concepts for treatment strategies and for the translation of the results to preclinical studies and, thereafter, in clinical practice.
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  • 文章类型: Journal Article
    世界各地的许多实验室都在提供脊髓小脑共济失调(SCA)的分子遗传测试。这对于鉴别诊断和适当的遗传咨询至关重要。欧洲分子遗传学质量网络(EMQN)于2004年启动了SCA外部质量评估计划。显然需要更新实验室指南。EMQN和EuroGentest组织了一次最佳实践(BP)会议,讨论当前的实践并达成共识。一项会前调查显示,36个实验室(20个国家)在前一年进行了近18000项SCA测试,并确定了要讨论的问题。会议结束后立即编写了准则草案,并在网上讨论了几个月。最终版本得到了EMQN的认可,并与其他寡核苷酸重复疾病的指南相协调。我们介绍了组织调查所采取的程序,BP会议,以及起草和批准BP指南。我们强调关于(1)预测试要求的最重要建议,(2)适当的方法和(3)解释和报告,并集中讨论未包括在最后文件中的有争议的问题。此外,经过对科学文献的广泛审查,并回应提出的建议,我们现在提供信息,希望这些信息将促进诊断实验室的活动并促进高质量的SCA测试。对于主要基因座,这包括(1)重复序列列表,(2)使用中的引物;(3)对正常和致病性重复大小范围的基于证据的描述,包括外显率降低的外显率和仍存在不确定性的外显率。这些信息将在http://www中进行维护和更新。scabase.欧盟。
    Many laboratories worldwide are offering molecular genetic testing for spinocerebellar ataxias (SCAs). This is essential for differential diagnosis and adequate genetic counselling. The European Molecular Genetics Quality Network (EMQN) started an SCA external quality assessment scheme in 2004. There was a clear need for updated laboratory guidelines. EMQN and EuroGentest organized a Best Practice (BP) meeting to discuss current practices and achieve consensus. A pre-meeting survey showed that 36 laboratories (20 countries) conducted nearly 18 000 SCA tests the year before, and identified issues to discuss. Draft guidelines were produced immediately after the meeting and discussed online for several months. The final version was endorsed by EMQN, and harmonized with guidelines from other oligonucleotide repeat disorders. We present the procedures taken to organize the survey, BP meeting, as well as drafting and approval of BP guidelines. We emphasize the most important recommendations on (1) pre-test requirements, (2) appropriate methodologies and (3) interpretation and reporting, and focus on the discussion of controversial issues not included in the final document. In addition, after an extensive review of scientific literature, and responding to recommendations made, we now produce information that we hope will facilitate the activities of diagnostic laboratories and foster quality SCA testing. For the main loci, this includes (1) a list of repeat sequences, as originally published; (2) primers in use; and (3) an evidence-based description of the normal and pathogenic repeat-size ranges, including those of reduced penetrance and those in which there is still some uncertainty. This information will be maintained and updated in http://www.scabase.eu.
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  • 文章类型: Journal Article
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  • 文章类型: Case Reports
    Dysfunctions of the somatosensory system are among the clinical signs that characterize a variety of polyglutamine or CAG-repeat diseases. Deficits within this system may hinder the perception of potential threats, be detrimental to somatomotor functions, and result in uncoordinated movements, ataxia, and falls. Despite the considerable clinical relevance of such deficits, however, no systematic pathoanatomical studies of the central somatosensory system in polyglutamine diseases are currently available. The present paper has two goals: (1) recommendation of an economical tissue sampling method and optimized histological processing of this tissue to allow rapid and reliable evaluation of the structural integrity of all known relay stations and interconnecting fibre tracts within this complex system, and (2) the proposal of guidelines for a rapid and detailed pathoanatomical investigative procedure of the human central somatosensory system. In so doing, we draw on the current state of neuroanatomic research and apply the methods and guidelines proposed here to a 25-year-old female patient with spinocerebellar ataxia type 2 (SCA2). The use of 100 microm serial sections through the SCA2 patient\'s central somatosensory components showed that obvious neuronal loss occurred in nearly all of the relay stations of this system (Clarke\'s column; cuneate, external cuneate and gracile nuclei; spinal, principal and mesencephalic trigeminal nuclei; ventral posterior lateral and ventral posterior medial nuclei of the thalamus), whereas the majority of interconnecting fibre tracts (dorsal spinocerebellar tract; cuneate and gracile fascicles; medial lemniscus; spinal trigeminal tract, trigeminal nerve and mesencephalic trigeminal tract) displayed signs of atrophy accompanied by demyelinization. These pathological findings suffice to explain the patient\'s impaired senses of vibration, position and temperature. Moreover, together with the lesions seen in the motor cerebellothalamocortical feedback loop (pontine nuclei, deep cerebellar nuclei and cerebellar cortex, ventral lateral nucleus of the thalamus), they also account for the somatomotor deficits that were observed in the young woman (gait, stance, and limb ataxia, falls, and impaired writing). In proposing these new guidelines, we hope to enable others to study the hitherto unknown morphological counterparts of somatosensory dysfunctions in additional CAG-repeat disease patients.
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